The Linacre Quarterly Volume 64 | Number 4 Article 1 November 1997 Life, Life Support, and Death Principles, Guidelines, Policies and Procedures for Making Decisions That Respect Life Paul A. Byrne William F. Colliton Joseph C. Evers Timothy R. Fangman Jerome L'Ecuyer See next page for additional authors Follow this and additional works at: http://epublications.marquette.edu/lnq Recommended Citation Byrne, Paul A.; Colliton, William F.; Evers, Joseph C.; Fangman, Timothy R.; L'Ecuyer, Jerome; Simon, Frank G.; Nilges, Richard G.; Shen, Jerome T.Y.; Kramper, Ralph J.; and Sadick, Mary H. (1997) "Life, Life Support, and Death Principles, Guidelines, Policies and Procedures for Making Decisions That Respect Life," The Linacre Quarterly: Vol. 64: No. 4, Article 1. Available at: http://epublications.marquette.edu/lnq/vol64/iss4/1 Life, Life Support, and Death Principles, Guidelines, Policies and Procedures for Making Decisions That Respect Life Authors Paul A. Byrne, William F. Colliton, Joseph C. Evers, Timothy R. Fangman, Jerome L'Ecuyer, Frank G. Simon, Richard G. Nilges, Jerome T.Y. Shen, Ralph J. Kramper, and Mary H. Sadick This article is available in The Linacre Quarterly: http://epublications.marquette.edu/lnq/vol64/iss4/1 Life, Life Support, and Death Principles, Guidelines, Policies and Procedures for Making Decisions That Respect Life by Paul A. Byrne, M.D., FAAP; William F. Colliton, Jr., M.D., FACOG; Joseph C. Evers, M.D., FAAP; Timothy R. Fangman, M.D.; Jerome L'Ecuyer, M.D., FAAP; Frank G. Simon, M.D.; Richard G. Nilges, M.D., FACS; Jerome T.Y. Shen, M.D., FAAP; Ralph J. Kramper, M.D., FAAFP, with Mary H. Sadick, J.D. ©1993 American Life League, Inc. Edition © 1996 The following is the third edition of a booklet by the American Life League, Inc. The section on Ordinary/Extraordinary Means has been revised. The sections on Quality of Life, Pain, Paired Organ and Non-vital Organ and Tissue Transplant, and Determination ofDeath have been added. There are other changes throughout the booklet. Introduction Some aspects of the euthanasia movement are clear, but many others are subtle, and the truth is not easily discerned. There is a paucity of truthful education regarding "brain death," death with dignity, living wills, and death by dehydration and starvation. All in society, especially physicians and heath care personnel, must become as familiar with these topics as they are with abortion. Both abortion and euthanasia are forms of imposed death. November, 1997 3 While most articles appearing in the medical literature have supported a public policy that would lead inexorably to the deaths of many of our patients, some good has resulted from this cacophony. All physicians, including those who support the principles detailed here, have been called to remember the dictum of Francis Peabody that "the secret of the care of the patient is in caringfor the patient."t The most essential ingredient required to accomplish this goal is two-way communication with the patient and his or her family. Beginning with the first visit of an adult patient, the doctor should strive to establish that kind of rapport which allows for an understanding of the responsibilities, obligations and duties of the patient himself or herself. Other medical personnel also should be involved in establishing such rapport. The topic of "brain death" has been pursued for many years by Dr. Paul Byrne; Dr. Joseph Evers; Dr. Richard Nilges; the late Dr. Sean O'Reilly; the late Fr. Paul Quay, S.1.; Attorney Peter Salsich; and others.2 The understanding and insight gained about the immoralitY of the use of the current criteria for "brain death" make it easier to take a stand against killing that is done by withdrawing or withholding food and water, and/or giving a lethal injection. We see a young, strong, vigorous man slam-dunk a basketball. Within seconds of all that activity, he collapses and then dies. He was surrounded by persons trained to do CPR (cardio-pulmonary resuscitation). Let's presume that everyone administered "all the best" that medicine had to offer. Still he died. The reality is that treatment does not always succeed at keeping a patient alive. Some treatments are helpful and do result in a patient's living longer. When ,a disease is lethal and there are multi-organs or multi-systems involved, the prognosis often is not good. Patients do die even while on a ventilator. At that time everyone can observe and know that death has occurred, even though the ventilator continues to move air into and out of the chest. What approach should be taken by a physician, patient and others regarding the use or non-use of a ventilator and other fonns of medical treatment? How should the dying patient be treated? When has death actually occurred? How should a patient's relatives consider these issues? The answers are not simple. Every decision must be individualized, especiaJIy when life and death are at stake. The 4 Linacre Quarterly common law right of a competent patient to refuse medical treatment does not diminish the duty of the physician or the moral obligation of the patient. Presented here are some principles, guidelines, policies and procedures to guide those making these and other medical decisions. The Major Premise Let's begin with human life is sacred. Leon Kass has written in Commentary that ". life is in itself something holy or sacred, transcendent, set apart-like God Himself ... [L]ife is something before which we stand (or should stand) with reverence, awe, and grave respect-because it is beyond us and unfathomable .. rTlo regard life as sacred means that it should not be violated, opposed or destroyed, and, positively, that it should be protected, defended and preserved . ,,3 God alone is the Author of a person's life, and He alone may detennine when a person's life will end. Since human life is a gift from God, there is a primary moral obligation to show reverence for that life at all times from its beginning until death. Any failure to show reverence for or to safeguard life is an attack on the individual patient, on others involved, on the medical profession, on society, and on God.4 No physician, nurse, other personnel or caregiver should participate in euthanasia. By euthanasia, we mean an action or an omission that of itself or by intention causes death. No one should be deprived of basic care, including food and water, suitable bedding, an optimal thennal environment, an unobstructed airway, exits for stool and urine, and effective treatments, medications, procedures and operations. A hospital exists to diagnose and treat ill patients. While not every illness can be cured, every patient must be cared for. The object is always to provide the best medical care to the whole person, physically, mentally, emotionally and spiritually. To purposefully expedite death by omission or commission violates a fundamental principle of medicine-"First, do no hann." Recognizing that not every illness can be cured but that every patient must be cared for, a hospital cooperates with other facilities and services as well as the patient's family to deliver the best care possi~le to the patient. November, 1997 5 OrdinarylExtraordinary Means Decisions to use or not to use a particular medical treatment, medication, procedure or operation should be considered according to "ordinary" and "extraordinary means." "Ordinary" and "extraordinary means" represent ethical constructs enabling an understanding of such decisions by the individual patient. As a general principle, a person has an obligation to try to live the entire life span given by God. Therefore, he/she must not kill himlherself by intentional act or omission. When it comes to specific decisions regarding medical treatment, this obligation requires the patient to use all "ordinary means" to preserve hislher life. "Ordinary means" include any treatment, medication, procedure and operation which offer a reasonable hope of benefit without requiring heroic virtue, that is, virtue above and beyond the ordinary. For example, an effective treatment which does not cause pain, expense or other burden that is grave or too excessive for the patient himselflherself to bear is ordinary means. On the other hand, life on earth for everyone will end, even when everything possible to be done is done. Thus, while the responsibility to avoid deliberately causing one's own death is absolute, the responsibility to preserve and prolong life is not. Because the constitution of the person, the ability of the person and the burdens of medical treatment differ from person to person, the obligation to obtain medical treatment varies, and there is no general obligation to obtain every treatment all the time. The burden of medical treatment could be extremely great, that is, beyond what would be expected of human beings in general, or even for this particular human being under certain circumstances. Therefore, some treatments, medications, procedures and operations are optional, and these have been classified by ethicists as "extraordinary means." "Extraordinary means" (or disproportionate means, as preferred by some in modern times) include any treatment, medication, procedure and operation that would be gravely burdensome for the patient to bear or otherwise would require heroic virtue. Here we are emphasizing that it is the means, that is, the treatment, medication, procedure or operation, which is gravely burdensome or otherwise requires heroic 6 Linacre Quarterly virtue. We use strong language-gravely burdensome; others use excessively burdensome or excessively difficult. Also, we use heroic virtue. We are not trying to be scrupulous, nor do we want others to be so. However, we do wish to make clear that the burden must be extremely great or the virtue required must be beyond ordinary virtue, before the means can be classified as extraordinary.